Abstract
Objective
The objective of this study was to characterize early and midterm outcomes after the
Ross/Ross-Konno procedure performed in infancy for severe aortic valve disease.
Methods
Between January 1995 and December 2018, 35 infants younger than 1 year (13 neonates)
underwent a Ross/Ross-Konno procedure. Patients were followed up to a median of 4.1 years
(interquartile range [IQR], 2.6-9.5). Primary outcome measures were survival, early
morbidity, freedom from reintervention and long-term functional and echocardiographic
status.
Results
Median age at operation was 49 days (IQR, 17-135) and weight was 4 kg (IQR, 3.4-5.2).
Thirty-one (89%) had undergone a previous procedure, including balloon valvuloplasty
in 26 (74%). Thirty (86%) required annular enlargement (Konno incision). Five required
concomitant aortic arch surgery (2 neonates, 3 infants). There were no early deaths,
and 1 late death at 18 months. Freedom from reoperation was 85% (95% confidence interval
[CI], 68%-93%) at 1 year, 76% (95% CI, 54%-88%) at 5 years, and 62% (95% CI, 36%-79%)
at 10 years. One modified Konno was performed at 5 years after a Ross in infancy.
Ten right ventricle to pulmonary artery conduits have required reintervention (2 percutaneous
pulmonary valve implantations). One child required a permanent pacemaker for complete
heart block. At latest follow-up, 32 (94%) of 34 survivors were asymptomatic. There was
no significant change in neoaortic Z-scores between 6 weeks and latest follow-up.
Conclusions
The neonatal and infant Ross/Ross-Konno procedure can be performed with low mortality
and achieves a stable left ventricular outflow tract. Significant early morbidity
reflects the preoperative condition of the patients but definitive surgery of this
type can be considered as a primary approach.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
CI (confidence interval), ECMO (extracorporeal membrane oxygenation), IQR (interquartile range), MCS (mechanical circulatory support), RV (right ventricle), RV-PA (right ventricle to pulmonary artery), SD (standard deviation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 07, 2021
Accepted:
June 20,
2021
Received in revised form:
June 2,
2021
Received:
March 9,
2021
Footnotes
The authors acknowledge the support of the Vivienne and Ross Hobson Trust, as well as the Wishaw Family Trust, gifts to the Heart Centre for Children.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Ross procedure in neonates and infants: Withstanding the litmus test of timeThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 2
- PreviewMore than 50 years after Donald Nixon Ross developed his eponymous procedure of replacing a diseased aortic valve with pulmonary autograft, the technique has become an established surgical option for aortic valve replacement.1 The Ross procedure offers superior hemodynamic parameters in comparison to alternative means for aortic valve replacement, avoidance of anticoagulation therapy, and growth potential for patients at younger ages. In the pediatric population, it is the sole option if valve repair is not feasible or fails.
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- Preview
- Commentary: Ross procedure is indeed a safe and durable option for critical aortic valve disease in neonates and infantsThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 2
- PreviewManagement of neonates and infants with critical aortic valve stenosis (AS) poses a significant challenge. The patients present with various degree of left ventricular dysfunction and endocardial fibroelastosis due to critical downstream obstruction, secondary pulmonary hypertension, and important additional lesions such as mitral valve dysplasia and aortic arch obstruction. Balloon aortic valvuloplasty has been a standard first intervention for these patients, but surgical intervention is needed when balloon valvuloplasty is ineffective or results in significant aortic insufficiency (AI).
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- Preview
